Social Science [?] Medicine

Published by Elsevier
Online ISSN: 0277-9536
Publications
Article
The object of this paper is to update the debate concerning the State's role in health systems services regarding the experience of the last decade. It is argued that it is impossible to give an account of the problem's complexity without bearing in mind the social science contribution concerning the crisis in Welfare States.
 
Article
This paper examines the health functions of the state in the F.R.G. in their historical, political and socio-economic inter-relationships. The main focus is on the antagonistic interests of the social classes. Special emphasis is placed on an analysis of the health political state intervention of 1974 which marked the beginning of the far-reaching economic crisis. There were serious restrictions placed on utilization such as co-payments and other interventions: commercialization; privatization; individualization; and the rationalization of public services. Moreover, as the data show, there have been massive transferences within the public service system at the expense of the socially insured.
 
Article
The aim of this review is to determine the frequency and circumstances under which predicting individuals' risk of illness has adverse psychological effects. Using systematic review methodology, the literature was searched for studies that had assessed the adverse psychological outcomes of risk assessment programmes. The outcomes investigated are emotional (anxiety, depression, distress) cognitive (intrusive thoughts, perceptions of health) and behaviour (work absenteeism). The impact of both positive and negative test results are summarised in terms of the number of studies showing significant effects between and within groups in the short (one month or less) and longer term (more than one month). Where sufficient data were available, a meta-analysis was conducted to assess effect size. Fifty-four studies met the criteria for inclusion. The studies assessed the impact of informing individuals about cardiovascular risk (21), risk of AIDS (eight), risk of cancer (10), risk of Huntington's disease (10), risk of diabetes (two), risk of spinocerebellar ataxia (one) and risk of osteoporosis (two). Overall, the quality of studies assessed was limited, with only two using a randomised design to determine the psychological impact of risk assessment. Receiving a positive test result was associated in the short term in the great majority of studies with depression, anxiety, poorer perceptions of health and psychological distress. Data were available for a quantitative synthesis of results on three outcomes, anxiety, depression and distress. Anxiety and depression were significantly higher in those tested positive compared with those tested negative in the short term but not the longer term. Distress could only be assessed in the longer term: there was no evidence of an increase for those receiving positive test results. The five experimental studies that reported interventions aimed at preventing some of these adverse effects all reported favourable results. There was little evidence of any adverse psychological effects of receiving an unfavourable test result. Adverse psychological effects are a common immediate consequence of positive test results following risk assessment. Results from the few experimental studies reviewed suggest that these adverse outcomes should not be seen as inevitable.
 
Article
Growing evidence for the existence of an aquatic reservoir of Vibrio cholerae has led some observers to postulate the existence of two distinct modes of disease transmission: primary and secondary. In primary transmission vibrios pass from the aquatic reservoir to humans via edible aquatic flora or fauna, or drinking water. Secondary transmission consists of faecal-oral transmission from person-to-person and may spawn epidemics. Cholera outbreaks are particularly well documented for the Matlab area of Bangladesh, where a field station has been run since 1963, at which patients from a study population of nearly 200,000 are treated for diarrhoeal diseases and monitored in a longitudinal demographic surveillance system. This paper seeks to illuminate the process of secondary transmission by presenting preliminary results of an analysis of the time-space distribution of cholera cases in Matlab for the period 1970-1982. It is argued that the detection of time-space clusters of cases resulting from secondary transmission requires locational data below the level of the village, that is at the level of the bari, or patrilineally-related household group because this is where inter-personal contact is greatest. The mapping of the study area at the bari level is described briefly and it is argued that the proportion of all asymptomatic infections and cases which can be mapped is great enough to enable inferences about transmission processes to be drawn. Results of the analysis of time-space interaction using the Knox method are presented and provide some support for within-bari clustering of cases resulting from secondary transmission.(ABSTRACT TRUNCATED AT 250 WORDS)
 
Participant fl ow diagram. 
PANEL A Impacts of full program (Phase 1). Impacts of "Wþ" partner inclusion (Phase 2). These panels display the standardized results of intention-to-treat (ITT) ordinary least squares (OLS) regressions of each outcome on an indicator of assignment to treatment among women (immediate treatment in Panel A (Phase 1); Wþ in panel B (Phase 2), a stratum fixed effect, and baseline covariates. The point estimates were standardized by dividing the coefficient on assignment by the control group standard deviation (Glass's D).
Impacts of full program (Phase 1): Primary outcomes and selected economic outcomes.
Article
Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011. In the first experiment, a cluster-randomized superiority trial, 15 marginalized people (86% women) were identified in each of 120 villages (n = 1800) in Gulu and Kitgum districts in Uganda. Half of villages were randomly assigned via public lottery to immediate treatment: five days of business training, $150, and supervision and advising. We examine intent-to-treat estimates of program impact and heterogeneity in treatment effects by initial quality of partner relations. 16 months after the initial grants, the program doubled business ownership and incomes (p < 0.01); we show that the effect on monthly income, however, is moderated by initial quality of intimate partner relations. We also find small increases in marital control (p < 0.05), self-reported autonomy (p < 0.10), and quality of partner relations (p < 0.01), but essentially no change in intimate partner violence. In a second experiment, we study the impact of a low-cost attempt to include household partners (often husbands) in the process. Participants from the 60 waitlist villages (n = 904) were randomly assigned to participate in the program as individuals or with a household partner. We observe small, non-significant decreases in abuse and marital control and large increases in the quality of relationships (p < 0.05), but no effects on women's attitudes toward gender norms and a non-significant reduction in autonomy. Involving men and changing framing to promote more inclusive programming can improve relationships, but may not change gender attitudes or increase business success. Increasing women's earnings has no effect on intimate partner violence. Copyright © 2015. Published by Elsevier Ltd.
 
Article
The assumption that social class inequalities in health are a persistent feature of the life-course has been questioned in a recent issue of this journal. On the evidence of mortality and chronic illness, the pattern in youth in Britain appears to be characterised by the lack of class differentials, a striking contrast to early adulthood where the familiar picture of health inequalities is observed. The possibility that this finding of relative equality in youth is a consequence of the limited, and potentially inappropriate, health indicators used has now been tested on a cohort of 15-year-olds in the West of Scotland. On a range of indicators, from subjective assessments to objective physical measures, very little evidence of class variation in health is found. The possible transience of the youth pattern is, however, indicated by findings from a cohort of 35-year-olds in the same study, among whom marked class gradients in health are apparent. Possible explanations for the transformation of a pattern of relative class equality in youth into one of inequalities in adulthood are discussed.
 
Article
This paper aims to study, at the population level, the protective role of breast-feeding on child health and its relation to day-care attendance during the first 5 years of life. The analysis, done on a national sample of children, uses antibiotic treatments as a general measure of health. It takes into account mother's education level, family poverty level, mother's smoking status during pregnancy and after birth, mother's age, sex, gestation duration, and birth rank. The analyses were performed using data from the Longitudinal Study of Child Development in Quebec (LSCDQ), conducted by Santé Québec, a division of the Institut de la Statistique du Québec (ISQ). The study was based on face-to-face interviews and included a set of questionnaires addressed to the children's mothers and fathers. A total of 1841 were included in the sample analyzed. Detailed information on breast-feeding and complementary feeding was collected at 5 and 17 months through face-to-face interviews with the most knowledgeable person, generally the mother. From this information, it has been possible to estimate breast-feeding duration and exclusivity. Our results indicate that the positive effects of breast-feeding on health persist up to the second year of life, even in the presence of day-care attendance. The analyses indicate that breast-feeding reduced the number of antibiotic treatments given to children entering day care before 2.5 years of age. The study also indicates that the more-at-risk children could be protected by breast-feeding and by being taken care of in a familial setting, especially before 2.5 years of age. Mother's education, family poverty level, and other social inequality indicators did not play a role in the frequency of antibiotic treatments. Over the long term, it will be important to continue to monitor the health of children and to implement public health interventions aimed at reducing health problems among children of preschool age.
 
Article
This study of Hmong refugees at 1.5 and 3.5 years following arrival in the United States showed considerable improvement on psychiatric self-rating scales. Social changes over the 2 year interim (including a high unemployment rate) were few. Earlier premigration and postmigration variables correlated with high symptom levels at 1.5 years were not correlated with these symptoms at 3.5 years. Events in the acculturation process which accompany, and perhaps account for some of these observations are indicated.
 
Article
The directly attributable effect of menopausal transition on women's quality of life (QoL) remains unclear. This study investigates the relationship between perceived change in QoL and menopausal transition status, socio-economic circumstances, lifestyle factors, and life stress. Prospective data were collected from a cohort of 1525 British women followed up since their birth in 1946 and annually from 47 to 54 years. Following factor analysis, the 10 survey items for perceived change were combined into three QoL domains: physical health (physical health, energy level, and body weight), psychosomatic status (nervous and emotional state, self-confidence, work life, ability to make decisions, and ability to concentrate), and personal life (family life and time for self, hobbies, and interests).
 
Article
Empirical research and the theory of natural selection assert that male mortality more than female mortality responds to ambient stressors in utero. Although population stressors may adversely damage males that survive to birth, the rival culled cohort hypothesis contends that males born during stressful times may exhibit better health than males in other cohorts because fetal loss has "culled" the frailest males. We tested these hypotheses by examining child developmental outcomes in a U.S. birth cohort reportedly affected in utero by the September 11, 2001 attacks. We used as outcomes the Bayley cognitive score and child height-for-age from the Early Childhood Longitudinal Study-Birth Cohort. Previous research demonstrates a male-specific effect of 9/11 on California infants born in December 2001. We, therefore, compared cognition and height of this cohort with males born prior to the 9/11 attacks. We controlled for unobserved confounding across gender, season, and region by using triple-difference regression models (N = 6950). At 24 months, California males born in December scored greater than expected in cognitive ability (coef = 9.55, standard error = 3.37; p = 0.004). We observed no relation with height. Results remained robust to alternative specifications. Findings offer partial support for the culled cohort hypothesis in that we observed greater than expected cognitive scores at two years of age among a cohort of males affected by 9/11 in utero. Contemporary population stressors may induce male-specific culling, thereby resulting in relatively improved development among males that survive to birth.
 
Article
This study compares eleven countries with respect to the magnitude of mortality differences by occupational class, paying particular attention to problems with the reliability and comparability of the data that are available for different countries. Nationally representative data on mortality by occupational class among men 30-64 years at death were obtained from longitudinal and cross-sectional studies. A common social class scheme was applied to most data sets. The magnitude of mortality differences was quantified by three summary indices. Three major data problems were identified and their potential effect on inequality estimates was quantified for each country individually. For men 45-59 years, the mortality rate ratio comparing manual classes to non-manual classes was about equally large for four Nordic countries, England and Wales, Ireland, Switzerland, Italy, Spain and Portugal. Relatively large ratios were only observed for France. The same applied to men 60 64 years (data for only 5 countries, including France). For men 30-44 years, there was evidence for smaller mortality differences in Italy and larger differences in Norway, Sweden and especially Finland (no data for France and Spain). Application of other summary indices to men 45-59 years showed slightly different patterns. When the population distribution over occupational classes was taken into account, relatively small differences were observed for Switzerland, Italy and Spain. When national mortality levels were taken into account, relatively large differences were observed for Finland and Ireland. For each summary index, however, France leads the international league table. Data problems were found to have the potential to bias inequality estimates, substantially especially those for Ireland, Spain and Portugal. This study underlines the similarities rather than the dissimilarities between European countries. There is no evidence that mortality differences are smaller in countries with more egalitarian socio-economic and other policies.
 
Article
In light of geographical and epidemiological research suggesting that the socioeconomic environment beyond the family may influence children's physical activity, this study investigated the extent to which neighbourhood socioeconomic conditions predict change in physical activity from ages 10 through 15 years, controlling for the attributes of the individual child and family. Data came from 889 children participating in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development cohort study. Accelerometers measured Moderate-to-Vigorous Physical Activity (MVPA) during the week and weekend, when the children were aged 10, 11, and 15 years. Selected US census block variables were used to create 'independent' area measures of economic deprivation and social fragmentation scores for child's area of residence at age 10 years. Also, parents' perception of neighbourhood social cohesion was measured in terms of relationships with neighbours. All analyses controlled for participant characteristics: gender, ethnicity, household income-to-needs ratio, maternal education, and for United States region of residence. Growth curve analyses indicated that whereas social fragmentation did not predict MVPA over time, greater area deprivation at age 10 years was associated with lower weekday MVPA for boys at 10 years (β=-0.5, p=0.03) and these differences persisted to age 11 and 15 years. This relationship was reversed for girls. Weekend MVPA was not significantly associated with the level of deprivation in the place of residence at age 10 years. Although the census measure of social fragmentation in the area of residence showed no significant association with MVPA, parent-reported neighbourhood social cohesion was positively associated with weekday (β=2.0, p<0.01) and weekend (β=3.1, p<0.01) MVPA minutes across time. This association was most pronounced for boys. Area level factors may be determinants of physical activity among children and youth in complex ways and parental perception of area social environment may be as important for children's activity levels as 'independently assessed' socioeconomic conditions.
 
Article
Socioeconomic health differences (SEHD) are relatively small in childhood. In adolescence they almost seem to disappear and among young adults they re-emerge. This article deals with mechanisms that contribute to the emergence of health differences by studying a group of 10-11 year old children in The Netherlands (n = 908). The role of determinants of health in the relation between socioeconomic status and health (causation) is studied, as well as the influence of health on school performance (selection). Both causation and selection mechanisms prove to exist. Life style and life circumstances are unequally distributed among the socioeconomic groups and can (partly) explain the relation between socioeconomic status and health. The health of the children is related with school performance, which can be seen as health selection. This relation however was only found in the lowest socioeconomic groups. In the lowest socioeconomic groups less healthy children perform worse at school than healthy children. The unequal distribution of determinants of health and health selection in the educational career among children probably contribute to SEHD in adult life.
 
Article
The September 11, 2001 terrorist attacks (9/11) presented a unique opportunity to assess the physical health impact of collective stress in the United States. This study prospectively examined rates of physical ailments and predictors of health care utilization in a U.S. nationally representative sample over three years following the attacks. A sample of adults (N = 2592) completed a survey before 9/11/01 that assessed MD-diagnosed physical and mental health ailments. Follow-up surveys were administered at one (N = 1923), two (N = 1576), and three (N = 1950) years post-9/11 to assess MD-diagnosed physical health ailments (e.g., cardiovascular, endocrine) and health care utilization. Reports of physical ailments increased 18% over three years following 9/11. 9/11-related exposure, lifetime and post-9/11 stress, MD-diagnosed depression/anxiety, smoking status, age, and female gender predicted increased incidence of post-9/11 ailments, after controlling for pre-9/11 health. After adjusting for covariates (demographics, somatization, smoking status, pre-9/11 mental and physical health, lifetime and post-9/11 stress, and degree of 9/11-related exposure), increases in MD-diagnosed cardiovascular, endocrine, gastrointestinal, and hematology-oncology ailments predicted greater utilization of health care services over two years. After the collective stress of 9/11, rates of physical ailments increased and predicted greater health care utilization in a U.S. national sample.
 
Article
Previous research has shown that early maturing girls at age 11 have lower subsequent physical activity at age 13 in comparison to later maturing girls. Possible reasons for this association have not been assessed. This study examines girls' psychological response to puberty and their enjoyment of physical activity as intermediary factors linking pubertal maturation and physical activity. Participants included 178 girls who were assessed at age 11, of whom 168 were reassessed at age 13. All participants were non-Hispanic white and resided in the US. Three measures of pubertal development were obtained at age 11 including Tanner breast stage, estradiol levels, and mothers' reports of girls' development on the Pubertal Development Scale (PDS). Measures of psychological well-being at ages 11 and 13 included depression, global self-worth, perceived athletic competence, maturation fears, and body esteem. At age 13, girls' enjoyment of physical activity was assessed using the Physical Activity Enjoyment Scale and their daily minutes of moderate-to-vigorous physical activity (MVPA) were assessed using objective monitoring. Structural Equation Modeling was used to assess direct and indirect pathways between pubertal development at age 11 and MVPA at age 13. In addition to a direct effect of pubertal development on MVPA, indirect effects were found for depression, global self-worth and maturity fears controlling for covariates. In each instance, more advanced pubertal development at age 11 was associated with lower psychological well-being at age 13, which predicted lower enjoyment of physical activity at age 13 and in turn lower MVPA. Results from this study suggest that programs designed to increase physical activity among adolescent girls should address the self-consciousness and discontent that girls' experience with their bodies during puberty, particularly if they mature earlier than their peers, and identify activities or settings that make differences in body shape less conspicuous.
 
Self-rated health, symptoms and depression (%) at ages 11, 13 and 15  
Article
This paper tests the hypothesis of an emerging or increasing female excess in general ill-health and physical symptoms, as well as psychological distress, during early to mid-adolescence. Self-reported data on general health (longstanding illness and health in the last 12 months), recent symptoms (classified as 'physical' and 'malaise') and depressive mood were obtained from a large, Scottish, school-based cohort at ages 11, 13 and 15. Generally high levels of health problems at age 11 tended to increase with age, these increases being greater for females than males, not only in respect of depression and 'malaise' symptoms, but also limiting illness, 'poor' self-rated health, headaches, stomach problems and dizziness. The consequence, by age 15, is the emergence of a female excess in general ill-health and depressive mood, and a substantial strengthening of the small excess in both 'physical' and 'malaise' symptoms already apparent at 11 years. These findings are discussed in relation to explanations for the adult female excess in poorer health, and the emergence of a female excess of depression during adolescence.
 
Article
This paper develops the concept of "biosecuritization" to describe new instantiations of the technological imperative in healthcare. Many discourses and practices surrounding hospitals' new investments in information and communication technologies tend to revolve around security provision. Often times, however, scenarios of extreme and exceptional circumstances are used to justify the implementation of identification and tracking technologies that may be more about managerial control than patient care. Drawing upon qualitative research in 23 U.S. hospitals from 2007 to 2009, our analysis focuses on hospitals' deployment of identification and location technologies that manage patients, track personnel, and generate data in real-time. These systems are framed as aiding in the process of managing supplies and medications for pandemic flu outbreaks, monitoring exposure patterns for infectious diseases, and helping triage or manage the location and condition of patients during mass casualty disasters. We show that in spite of the framing of security and emergency preparedness, these technologies are primarily managerial tools for hospital administrators. Just as systems can be used to track infection vectors, those same systems can be used on a daily basis to monitor the workflow of hospital personnel, including nurses, physicians, and custodial staff, and to discipline or reward according to performance. In other words, the biosecuritization modality of the technological imperative leads to the framing of medical progress as the "rationalization" of organizations through technological monitoring, which is intended to promote accountability and new forms of responsibilization of healthcare workers.
 
Article
This study used the Canadian version of the World Health Organization-Health Behaviour in School-Aged Children (WHO-HBSC) Survey to examine the role of multiple risk behaviours and other social factors in the etiology of medically attended youth injury. 11,329 Canadians aged 11-15 years completed the 1997-1998 WHO-HBSC, of which 4152 (36.7%) reported at least one medically attended injury. Multiple logistic regression analyses failed to identify an expected association between lower socio-economic status and risk for injury. Strong gradients in risk for injury were observed according to the numbers of multiple risk behaviours reported. Youth reporting the largest number (7) of risk behaviours experienced injury rates that were 4.11 times (95% CI: 3.04-5.55) higher than those reporting no high risk behaviours (adjusted odds ratios for 0-7 reported behaviours: 1.00, 1.13, 1.49, 1.79, 2.28, 2.54, 2.62, 4.11; p(trend) < 0.001). Similar gradients in risk were observed within subgroups of young people defined by grade, sex, and socio-economic level, and within restricted analyses of various injury types (recreational, sports, home, school injuries). The gradients were especially pronounced for severe injury types and among those reporting multiple injuries. The analyses suggest that multiple risk behaviours may play an important role in the social etiology of youth injury, but these same analyses provide little evidence for a socio-economic risk gradient. The findings in turn have implications for preventive interventions.
 
Article
Binge drinking has been shown to be associated with considerable social harm and disease burden. This review aims to give an overview from a European perspective of the socio-demographical, individual, and social factors that affect binge drinking and to identify effective interventions to reduce binge drinking. To this end, a computer-assisted search of relevant articles was conducted. Results showed that males tended to binge drinking more frequently than females. Binge drinking was most prevalent among adolescents and young adults, and prevalence levelled off later in life. Socio-economic conditions seemed to have an effect on binge drinking, independent of their effects on the volume of alcohol consumed. The early onset of binge drinking was associated with a history of drinking in the family, but pathways into adulthood are less clear. Binge drinking often co-occurred with other substance use. Motives for binge drinking included both social camaraderie and tension reduction. Which aspect prevails may vary according to the type of binge drinker, but to date has not been satisfactorily explained. Binge drinkers were not likely to know enough about or be aware of the potential risks of bingeing. Pressure from peers was one of the strongest influencing factors for binge drinking and seemed to outweigh parental influences, especially from late adolescence onwards. Binge drinking also varied according to both the predominant adult and adolescent drinking culture with more binge drinking in the northern and middle parts of Europe compared to the southern parts. Thus, a variety of socio-demographical, individual, and social characteristics associated with binge drinking have been identified. However, knowledge in this area is limited, as most research has been conducted among particular groups in specific situations, in particular North American college students. More research in Europe is urgently needed, as results from other cultural backgrounds are difficult to generalize.
 
Article
Our replication of Deaton and Lubotsky's [(2003). Mortality, inequality and race in American cities and states. Social Science & Medicine, 56.] study "Mortality, Inequality and Race in American Cities and States" identifies a coding error in the econometric analysis in the original paper. Correcting the error changes the basic results of the paper with respect to inequality and mortality in a relevant and substantive way. We also propose an alternative interpretation of the other main result of the paper regarding racial composition and mortality.
 
Article
In 1987 we conducted a mailed questionnaire survey involving 250 GPs, randomly drawn from the 3061 GPs in the 'Rhône-Alpes' region in France, in order to study how general practitioners (GPs) react to information about drugs in terms of their prescribing practices. The aim of the questionnaire was to investigate the GPs reactions (prescription intentions) to 25 statements containing information concerning drugs. These included results from randomized clinical trials with adequate clinical criteria (pertinent information), but there were also some statements containing non-relevant information such as intermediate criteria, physiopathological or pharmacological information, and some containing general information such as advice from colleagues, the established position of the drug etc. The GPs were also asked through which channels they commonly received therapeutic information (i.e. medical journals, conferences). A total of 117 GPs returned completed questionnaires. We found the prescription intentions, for pertinent information to be between 76.9% and 95.7%, whilst the intentions, as a result of personal knowledge and/or success with a drug were around 93%. More theoretical information resulted in prescription intentions which were more widely scattered (between 23.1% and 80.3%), and for external advice the intentions were not as high but they were also widely scattered (between 3.4% and 65%). The search for latent dimensions corresponding to GPs reactions to therapeutic information, with both principal component analysis and Rasch Modelling, showed that two orthogonal latent dimensions, i.e. 'sensitivity to clinical and theoretical information', and 'sensitivity to external standards', best explained the responses to the questionnaire. These two dimensions appeared to be independent of age, sex, medical school and type of practice (urban, rural). The use of the journal 'Prescrire' by GPs was found to be significantly associated (P less than 0.005) with low scores, or good quality of perception of pertinent information in the first dimension. The use of specialists' prescriptions was associated with similar scores for the first dimension, but also with poor quality of perception of pertinent information scores (i.e. high scores) for the second dimension. These results could be used to draw up proposals for the improvement of post-graduate medical education, which should take into consideration these two dimensions of therapeutic information assessment by doctors, in order to obtain better quality of perception profiles for information assessment and prescription by doctors.
 
Article
Public health and its "basic science", epidemiology, have become colonised by the individualistic ethic of medicine and economics. Despite a history in public health dating back to John Snow that underlined the importance of social systems for health, an imbalance has developed in the attention given to generating "social capital" compared to such things as modification of individual's risk factors. In an illustrative analysis comparing the potential of six progressively less individualised and more community-focused interventions to prevent deaths from heart disease, social support and measures to increase social cohesion faired well against more individual medical care approaches. In the face of such evidence public health professionals and epidemiologists have an ethical and strategic decision concerning the relative effort they give to increasing social cohesion in communities vs expanding access for individuals to traditional public health programs. Practitioners' relative efforts will be influenced by the kind of research that is being produced by epidemiologists and by the political climate of acceptability for voluntary individual "treatment" approaches vs universal policies to build "social capital". For epidemiologists to further our emerging understanding of the link between social capital and health they must confront issues in measurement, study design and analysis. For public health advocates to sensitise the political environment to the potential dividend from building social capital, they must confront the values that focus on individual-level causal models rather than models of social structure (dis)integration. The evolution of explanations for inequalities in health is used to illustrate the nature of the change in values.
 
Article
A sample of unemployed British men was interviewed for a third time after an average of 25 months continuous unemployment. As predicted, it was found that mental health, indexed in terms of affective well-being, had improved slightly since the previous interview. Adaptation of this kind was greater for men who had previously reported lower commitment to having a job and greater contact outside their immediate family, and also for those at the extremes of the age range. Measured availability of money and quality of social relationships were not related to adaptation. Changes in aspiration, autonomy and competence were considered likely to underpin the improvement in well-being. The need to study these additional components of mental health was emphasized, in order to determine when improvements in reported well-being should be considered 'healthy' or 'unhealthy'.
 
Article
Recent studies examining the medical and psychosocial sequelae of bone marrow transplantation have reported most survivors do relatively well while a smaller group continues to experience less than optimal quality of life (QOL). Many of these studies are limited by small sample sizes, limited scope, and focus on a narrow (1-4 year) window of survival. The descriptive survey examined the QOL, late medical complications, psychological distress, demands of long-term recovery, and health perceptions of 125 adults surviving 6-18 (mean 10) years after marrow transplantation. Seven wide-ranging tests covering 271 items were completed on average in 90 min. Two tests were developed by the authors specifically for assessing QOL in this population. 74% of long-term survivors of bone marrow transplantation reported their current QOL was the same or better than before transplantation, 80% rated their current health status and QOL as good to excellent, and 88% said the benefits of transplantation outweighed the side effects. Ten years or more post-transplantation, long-term survivors continued to experience a moderate incidence of lingering complications and demands, including emotional and sexual dysfunction, fatigue, eye problems, sleep disturbance, general pain and cognitive dysfunction. However, the severity or degree of distress attributed to those complications was, for most survivors, consistently low. Nearly all were back to work or school. Only 5% rated both their QOL and health status as poor. Long-term survivors demonstrated good mood and low psychological distress compared to cancer and population norms, and had the same perceptions as the general population of their current health and expectation of future health. Demands attributed to long-term survival appeared to impose little hardship. The most frequently cited demand of recovery was the perceived lack of social support as time went on. Almost all long-term survivors were leading full and meaningful lives. Persistent complications were, on the whole, dismissed as relatively trivial and the overwhelming majority viewed themselves as cured and well.
 
Article
This article shows the influence of ethnicity and social class on self-rated illness compared with social factors and lifestyle. We were particularly interested in health differences between refugees and labour migrants. The study population consisted of 223 Latin American refugees domiciled in Lund, 333 Finnish and 126 South European labour migrants and 841 Swedish controls. The data were analysed unmatched with logistic regression (multivariate analyses) in main effect models. The strongest independent risk indicator for long-term illness was being a Latin American refugee, with an estimated odds ratio of 2.78 (1.95-3.81), or a South European 1.80 (1.17-2.71). Low social class, low material standard, age 45-64 years and overweight were significantly associated with long-term illness. There was a strong association between being a Latin American refugee and ill-health, followed by a weaker association for South European labour migrants and no association for Finlanders and Swedes when controlled for other social factors in logistic regression. Low social class, age 45-64 years, poor social network, not feeling secure in daily life and not taking regular exercise were associated with ill-health. South Europeans were the only ethnic group who showed an association to working impairment and disability. Latin Americans were significantly associated with acute illness with an estimated odds ratio of 2.00 (1.32-2.94). In conclusion, ethnicity was shown to be an independent powerful social dimension compared with social class in relation to self-rated illness.
 
Article
Sex differences in mental disorder rates have been examined from two opposing perspectives. One of these suggests that women have higher rates due to sex role related stress [1. Am. J. Sociol. 78, 812, 1972; 2. Gender and Disordered Behavior, p. 23. Brunner/Mazel, New York, 1979]. The other holds that women do not have generally higher rates than men but rather that they manifest different types of psychiatric disorders [3. A. Rev. Psychiat. 25, 417, 1974; 4. Am. J. Sociol. 81, 1447, 1976]. This paper develops a theoretical paradigm to clarify and extend the latter position thereby facilitating an empirical test of the two opposing positions. Psychiatric disorder rates are examined for women living in two communities with contrasting sex role norms, the traditional Orthodox Jewish community with traditional sex role norms and the modern Orthodox Jewish community with changing sex role norms. The sex role stress perspective and the theoretical paradigm developed here lead to different predictions regarding the comparative disorder rates among these women. The observed rates of disorder are not consistent with the role stress theory.
 
Article
The introduction of the contraceptive implant Norplant has focused attention on how social factors may affect contraceptive use. In the United States, race is a central category of social organization which may impact Norplant use. I use data from the 1995 National Survey of Family Growth to answer three main questions. (1) Are women of color more likely to use Norplant? (2) To what extent can racial differences in Norplant use be explained by a structural bias in the provision of medical care? (3) To what extent can racial differences in Norplant use be explained by life circumstances which may affect individual women's contraceptive decisions? I find that African American and Native American women are more likely than white or Asian American women to be recent Norplant users. There are no differences in recent use by Hispanic origin. Both a structural bias in the provision of care and differences in life circumstances account for the disparity in Norplant use between African Americans and whites. However, none of the factors examined here explain Native American women's high rate of use. Concerns about health risks for Norplant use are also discussed. These findings point out the importance of examining structural, individual and health status factors in studies of the use of health services.
 
Article
Using data from a research registry of prescriptions, we studied benzodiazepine use in a Swedish community with a general population of 20,000. A sample of benzodiazepine users in 1976 (n = 561) aged 15 years and older was identified and followed for 13 years with respect to continued benzodiazepine use. A strong tendency towards continued use was observed. A majority of the cohort, 65%, continued benzodiazepine use during the first follow-up year, and 55% used benzodiazepines during the second. One-quarter of the sample continued using benzodiazepines during all years of the 13-year follow-up. One of the aims was to analyze factors predicting long-term benzodiazepine use. The multivariate analyses, using Cox regression analysis, showed that frequent/daily use and age were important factors. Gender and type of generic benzodiazepine were of little importance. Further, patients who were prescribed benzodiazepines by doctors working at hospitals and those who obtained prescriptions from both primary and hospital care physicians continued to use benzodiazepines to a greater extent than those patients who obtained prescriptions only from private practitioners or health center doctors. Another aim was to analyze to what extent long-term users were using these drugs on an infrequent, occasional, frequent, or daily basis and to what extent this use changed over time. Of those with benzodiazepine use persisting for eight or more years (n = 119), between one-half and two-thirds were frequent or daily users in each of those years. Because repeated measurements for the same individuals were analyzed, the generalized estimating equations (GEE) method was chosen for the multivariate analyses. Among long-term users, age, a combined use of tranquilizers and hypnotics, and prescriptions from more than one of the prescriber categories studied (i.e. doctors working at health centers, hospital doctors, and private doctors) were significant factors in frequent or daily use. The study also showed that frequent/daily use increased among the identified long-term users during the time period analyzed.
 
Article
This article extends our understanding of the everyday practices of pharmaceuticalisation through an examination of moral concerns over medication practices in the household. Moral concerns of responsibility and discipline in relation to pharmaceutical consumption have been identified, such as passive or active medication practices, and adherence to orthodox or unorthodox accounts. This paper further delineates dimensions of the moral evaluations of pharmaceuticals. In 2010 and 2011 data were collected from 55 households across New Zealand and data collection techniques, such as photo- and diary-elicitation interviews, allowed the participants to develop and articulate reflective stories of the moral meaning of pharmaceuticals. Four repertoires were identified: a disordering society repertoire where pharmaceuticals evoke a society in an unnatural state; a disordering self repertoire where pharmaceuticals signify a moral failing of the individual; a disordering substances repertoire where pharmaceuticals signify a threat to one's physical or mental equilibrium; a re-ordering substances repertoire where pharmaceuticals signify the restoration of function. The research demonstrated that the dichotomies of orthodox/unorthodox and compliance/resistance do not adequately capture how medications are used and understood in everyday practice. Attitudes change according to why pharmaceuticals are taken and who is taking them, their impacts on social relationships, and different views on the social or natural production of disease, the power of the pharmaceutical industry, and the role of health experts. Pharmaceuticals are tied to our identity, what we want to show of ourselves, and what sort of world we see ourselves living in. The ordering and disordering understandings of pharmaceuticals intersect with forms of pharmaceuticalised governance, where conduct is governed through pharmaceutical routines, and where self-responsibility entails following the prescription of other agents. Pharmaceuticals symbolise forms of governance with different sets of roles and responsibilities.
 
Article
Female circumcision is widespread in Egypt. Research suggests that the practice persists because of a belief that circumcision will moderate female sexuality, that it will assure a girl's marriagability, and that it is sanctioned by Islam. Using data from a nationally representative survey of adolescents, this paper investigates the prevalence and social correlates of circumcision among girls aged 10-19, the circumstances surrounding the procedure, and the attitudes of adolescents towards it. While the vast majority of adolescents are circumcised, a life table analysis indicates that girls today are at least 10 percentage points less likely to undergo female circumcision than were their mothers. Circumcision may have begun to decline prior to the time when the current cohort of girls were at risk; however, the data hint at a temporal association between the decline and the 1994 International Conference on Population and Development (ICPD) in Cairo, a time when the campaign against circumcision gained momentum. Over half of circumcised girls reported that the procedure was performed by a physician or nurse rather than a traditional practitioner. This represents a substantial increase over rates of "medicalized" circumcision found among earlier cohorts of Egyptian women. Even among circumcised girls, support for the practice is by no means universal, with 14 percent saying they think the procedure is unnecessary and a further 28 percent expressing ambivalence. A multivariate analysis indicates that girls who have been or are currently in school, who live in urban governorates, and who are older are more likely to believe that circumcision is not obligatory. When the analysis includes boys as well as uncircumcised girls, a large gender gap emerges, with boys considerably more supportive of the practice than are their female counterparts.
 
Article
The high rate of HIV infection among youth in Africa has prompted both national and international attention. Education and prevention programmes are seen as the primary way of decreasing this rate. This paper reviews 11 published and evaluated school-based HIV/AIDS risk reduction programmes for youth in Africa. Most evaluations were quasi-experimental designs with pre-post test assessments. The programme objectives varied, with some targeting only knowledge, others attitudes, and others behaviour change. Ten of the 11 studies that assessed knowledge reported significant improvements. All seven that assessed attitudes reported some degree of change toward an increase in attitudes favourable to risk reduction. In one of the three studies that targeted sexual behaviours, sexual debut was delayed, and the number of sexual partners decreased. In one of the two that targeted condom use, condom use behaviours improved. The results of this review suggest that knowledge and attitudes are easiest to change, but behaviours are much more challenging. The article provides details about programmes and identifies characteristics of the most successful programmes. Clearly, however, more research is needed to identify, with certainty, the factors that drive successful school-based HIV/AIDS risk reduction programmes in Africa.
 
Article
Trauma-related coping self-efficacy (CSE), the perceived capability to manage one's personal functioning and the myriad environmental demands of the aftermath of potentially traumatic events (PTE), has been shown to affect psychological outcomes after these events. Aim of the present four-wave study was to examine the cross-lagged relationships between CSE and posttraumatic stress disorder (PTSD) symptoms following PTEs in order to examine direction of influence. Levels of CSE and PTSD symptoms were measured with 4-month intervals. In addition, prospectively assessed personality traits and general self-efficacy perceptions as well as peritraumatic distress were entered in the analyses. The study sample consists of adult respondents of a representative internet panel who experienced PTE in the six months before T1, and did not experience any new PTE or life event between T1 and T3 (N = 400). Respondents were administered the coping self-efficacy scale (CSE-7), impact of event scale (IES) and arousal items of IES-R at each wave (T1 through T3), as well as questions on peritraumatic stress and prospectively measured personality traits (T0). Results of structural equation modeling showed that the effect of CSE on subsequent PTSD symptom levels was dominant. CSE significantly predicted subsequent symptoms, over and above earlier symptom levels, with higher CSE associated with lower PTSD. Symptoms in turn, did not predict subsequent levels of CSE. Higher peritraumatic distress was associated with both higher initial PTSD symptoms and lower initial CSE levels. Higher levels of the personality traits of emotional stability and agreeableness were associated with higher initial CSE levels. This supports a model in which CSE perceptions play an important role in recovery from trauma. Copyright © 2015 Elsevier Ltd. All rights reserved.
 
Article
The social policy background to the proliferation of patient satisfaction surveys is a desire for increased patient representation and participation. Within this context, it is assumed that satisfaction surveys embody patients' evaluations of services. However, as most surveys report high satisfaction levels, the interpretation of satisfaction as the outcome of an active evaluation has been called into question. The aim of this study is to identify whether and how service users evaluate services. This was made possible through unstructured in-depth interviews with users of mental health services and through more structured discussion around their responses on a patient satisfaction questionnaire (CSQ 18B) whose psychometric properties has been well documented. Twenty-nine people with current or recent contact with mental health services within the British National Health Service were interviewed. The data revealed that service users frequently described their experiences in positive or negative terms. However, the process by which these experiences were transformed into "evaluations" of the service was complex. Consequently, many expressions of "satisfaction" on the CSQ 18B hid a variety of reported negative experiences. An explanation for this lack of correspondence is outlined.
 
Article
We focus on physical and psychosocial job characteristics as mediators in the relationship between socioeconomic status (SES) and health. From sociological research on the stratification of employment outcomes we expect that people with less education, lower earnings, and lower levels of occupational standing have more physically and psychosocially demanding jobs. From the occupational stress, ergonomics, and job design literatures, we expect that people with more physically and psychosocially demanding jobs have less favorable health outcomes. Consequently, we expect to find that job characteristics play an important mediating role in associations between SES and self-assessed overall health and cardiovascular and musculoskeletal health problems. To address these hypotheses, we use data from the Wisconsin Longitudinal Study (WLS). We find support for our hypotheses, although the extent to which job characteristics mediate SES-health relationships varies across health outcomes and by sex.
 
Article
High levels of social capital and social integration are associated with self-rated health in many developed countries. However, it is not known whether this association extends to non-western and less economically advanced countries. We examine associations between social support, volunteering, and self-rated health in 139 low-, middle- and high-income countries. Data come from the Gallup World Poll, an internationally comparable survey conducted yearly from 2005 to 2009 for those 15 and over. Volunteering was measured by self-reports of volunteering to an organization in the past month. Social support was based on self-reports of access to support from relatives and friends. We started by estimating random coefficient (multi-level) models and then used multivariate logistic regression to model health as a function of social support and volunteering, controlling for age, gender, education, marital status, and religiosity. We found statistically significant evidence of cross-national variation in the association between social capital variables and self-rated health. In the multivariate logistic model, self-rated health were significantly associated with having social support from friends and relatives and volunteering. Results from stratified analyses indicate that these associations are strikingly consistent across countries. Our results indicate that the link between social capital and health is not restricted to high-income countries but extends across many geographical regions regardless of their national-income level.
 
Article
The role of family, friends and confidants in mediating the impact of adverse life events on psychosomatic symptoms in mid-adolescence was studied. School children (n = 2013) completed questionnaires in class on three occasions during 17 months. Data about social support and life events for 12 months were gathered retrospectively in the final questionnaire. The differences in symptoms by life events and social support were already present at the beginning of the study. Those adolescents who had experienced adverse life events and reported a poor relationship with one or both parents had the highest levels of symptoms and the greatest increase in symptoms during the follow-up. Lack of friends was also associated with psychosomatic symptoms, especially among those who had experienced adverse life events. The results suggest that adolescents who lack parental or peer support are at risk for psychosomatic symptoms in general, and especially in the face of stressful life events.
 
Article
Health selection, as one of the several possible explanations for social inequities in health, has been receiving more attention recently but few researchers turn the issue into a question of discrimination. The aim of the study was to analyse the impact of health in young age for social position in adult age and to discuss health selection in terms of discrimination from a gender-theoretical perspective. A prospective cohort study was conducted, in which all pupils (N = 1083) in the last year of compulsory school in a middle-sized municipality in northern Sweden were followed for 14 years. The response rate was high, with 96.6% still participating after 14 years. The data were collected through repeated comprehensive self-administered questionnaires as well as through teacher interviews and register data. Health selection was analysed in a multiple logistic regression model, with working-class position at age 30 as a dependent variable and different measures of health/health behaviour at age 16 and 21 as independent variables. Overall, the impact of early health/health behaviour on future socioeconomic position was small or non-existent. However, even after correction for possible mediating and moderating mechanisms, being overweight at age 16 and at age 21 was related to future working-class position among women only. Possible mediating mechanisms were feeling looked down upon, not being active in associations and not reading cultural/political events in daily newspapers. Early menarche together with early motherhood and low education could not explain the correlations. Our results indicate that overweight girls and young women are exposed to gendered discrimination which probably occurs in many arenas, based on the societal norms for female bodies in our society. There is a need to redirect research on health selection into gender research in order to further explore the subject as well as the possible mechanisms of gendered discrimination.
 
Article
Injuries in childhood are strongly related to poverty at the household level and to living in a deprived neighbourhood, but it is not clear whether these effects are independent. In this prospective population study, all injuries to 5-14 year old children living in the city of Norwich, UK, and presented at the hospital Accident and Emergency Department over a 13 month period were recorded (N=3526). Information on the population of resident children and household composition was assembled from the health authority population register. Neighbourhood information was extracted from the census and local surveys. Unadjusted risks were calculated for individual and neighbourhood factors, followed by multilevel modelling in which predictors were included at three levels: individual, enumeration district and social area (neighbourhood). The overall injury rate was 16.44 per 100 children per year. Injury rates between neighbourhoods varied two-fold and were highest in more deprived areas. In the final multilevel model injury risk was related to gender (boys vs. girls OR=1.35), age of child (OR=1.07 per year), number of adults in the household (OR=0.91 per adult), and age gap between child and eldest female (15-24 years vs. 25-34 years, OR=1.15). Injury rates were also related to social area deprivation, although variations in injury rates between neighbourhoods were not wholly explained by deprivation. The adjusted odds ratio between the most and least deprived social areas was 1.35. Excluding less serious injuries did not substantially change the results. The risks were very similar to those found in a previous study of pre-school children, with the same neighbourhoods identified as high and low risk as before. This evidence that neighbourhood factors independently influence injury risk over and above individual and household factors supports the use of area-based policies to reduce injuries in children.
 
Article
The hypothesis of the study was that social contacts to close friends and relatives and perceived social integration was able to delay mortality in general and cardiovascular mortality in particular. Altogether 1752 males and females, aged 70-100 years were interviewed by trained nurses in 1972 to 1974. The study group was based upon a random sample of all elderly in the town of Odense, Denmark. More than 80% participated in the survey which included data collection on social networks and health at the time of interviewing. By means of linking the study group to national registries on mortality and causes of mortality practically all in the cohort were traced until 1987. During follow-up 1501 persons died. Most of the association between social networks and mortality were weak and statistically insignificant but had the expected sign. After adjusting for initial health status only the interviewer's assessment of the quality of the network was statistically significant associated with longevity. A feeling of loneliness was found to be associated with cardiovascular mortality, especially for males.
 
Distribution of birth order (in percent) by social class at birth for children born alive at the Uppsala Academic Hospital during 1915-29 
Range and mean/percentage of the independent variables used in the analyses 
Infancy (0-12 months): odds ratios for all-cause mortality by birth order group and sex a 
Adulthood (20-54 years): Poisson regression; relative risk of all-cause mortality by birth order and sex a 
Article
The present study examines the sex-specific patterns of mortality by birth order in four stages of the life-course, using Poisson and logistic regression analysis. The main question posed is whether there is any continuing social effect of birth order when (a) biological factors at birth, (b) other social factors at birth and (c) socio-economic circumstances in adulthood are adjusted for. The analyses are based on the Uppsala Birth Cohort Study consisting of all 14,192 boys and girls who were born alive at the Uppsala Academic Hospital in Sweden during the period 1915-9. The results showed that all-cause mortality differed according to birth order in all of the four studied age intervals when birth year, mother's age, birth weight, gestational age, diseases of mother, diseases of the infant, social class and mother's marital status at the time of childbirth were adjusted for. The general tendency was for laterborn siblings, particularly girls women, to demonstrate a higher mortality risk than firstborn children. However, in the oldest age group (55-80 years) the previously significant association between birth order and male mortality became insignificant when adult socio-economic circumstances were controlled for. This indicates that the long-term influence of childhood birth order position on mortality is partly mediated by adult social class, education and income. The concluding section of the paper notes that laterborn children, and especially girls, were a disadvantaged group in early 20th century Sweden. Thus, for the subjects in the present study, the childhood social conditions linked to birth order position seem to have had consequences for these individuals' health and survival that extend over the whole life-course.
 
Article
Recent years have seen increasing recognition paid to the relation of religiousness/spirituality (R/S) to health care and research. This has led to the development of more inclusive and trans-culturally validated measurements of R/S. This paper comments on the WHOQOL SRPB Group's "A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life" (62: 6, 2005, 1486-1497), a recently published paper in Social Science & Medicine, and illustrates a possible problem in the measurement of R/S, especially as related to the study of mental health outcomes. Some scales have included questions about psychological well-being, satisfaction, connectedness with others, hopefulness, meaning and purpose in life, or altruistic values as part of their measure of R/S. These questions are really tapping indicators of mental health, and should not be included in the definition of R/S itself. Otherwise, tautology is the result, and it should not be surprising that such measures of R/S (defined by questions tapping mental health) are related to mental health outcomes.
 
Article
HIV risk behaviors and seroprevalence are particularly high among street youth. Though many programs have been designed to serve them, street youth have low rates of service utilization. The aim of this street-based, ethnographic project was to study the social and cultural context of street life in this population. Data were collected by participant observation, exploratory interviews and semi-structured interviews. Twenty street youth (15-23 years old; six female), recruited from street sites in San Francisco, participated in the interviews. Field notes and transcriptions were analyzed using an inductive technique for model building. This analysis yielded a proposed model of the life cycle of youth homelessness. In the first on the street stage, youth face an intense psychological feeling of outsiderness, and an urgency to meet basic needs. These stresses either lead to an escape from street life or to a process of acculturation to the street. Initiation to the street is facilitated by street mentors, who provide youth with survival skills. In the stasis stage, youth reach a tenuous equilibrium in which they can meet their basic needs. A strong street ethic allows youth to rationalize significant conflicts and frequent physical suffering. Youth in stasis are repeatedly thrown into disequilibrium, crises that frequently cause them to come into greater contact with mainstream society. After repeated episodes of disequilibrium, some youth extricate themselves from street life, finding a new identity in mainstream society. Otherwise, youth return to the street, in an episode of recidivism. The life cycle model suggests that street youth who are most open to intervention are those who are in transitional states, i.e., those who have just arrived on the street or those who are in crisis (disequilibrium). If this model is validated in a larger population of youth, programs that are aimed at these two stages in the life cycle could potentially effectively complement existing programs, which are usually focused on youth in stasis.
 
Article
Ethnic and religious minorities often suffer disadvantages both in socio-economic status and in health. Data from the West of Scotland Twenty-07 study suggest some differences in morbidity between those descended from Irish Catholic migrants of the great emigration from 1840 onwards and others. Catholic religion of at least one parent or at birth is used here as a proxy measure to indicate Irish Catholic descent, on the basis of estimates of sensitivity and specificity in the local area. Higher proportions of "Catholics" are in manual social classes. Differences between "Catholics" and "non-Catholics" in one or more age cohorts are observed for the following aspects of health and physical development: general and physical health (self-assessed health, number of symptoms, accidents), psychological distress (depression, anxiety, number of psychosomatic symptoms), impairments and disabilities (sight, hearing, wearing dentures, disability), and physical measures (height, waist-to-hip ratio, lung function). Furthermore, for all aspects except hearing, wearing dentures and number of psychosomatic symptoms, significant differences remain after accounting for sex and social class. For each measure where a difference is observed, it is those respondents with a Catholic parent or who were born Catholic who experience poorer health or physical development. This suggests that those of Irish Catholic descent are at some disadvantage compared with the rest of the population, with respect to health as well as social class, 150 years after the start of the main migration.
 
Article
This paper is concerned with understanding why some women accept their invitation for free screening mammography and others do not. Free screening mammography is offered to women aged 50-64 in Britain. Uptake of invitations is about twice as high in leafy suburbs than in inner-city areas. Low uptake in inner-city areas has been attributed to "problems" of black and minority ethnic women. The research reported here was carried out in Hackney, an inner city London borough with an ethnically diverse and socially deprived population. Hackney also has the lowest uptake of screening mammography in the country. Twenty focus groups were held. Participants included white, black and minority ethnic women. Eight focus groups were conducted in English; 12 in other languages. Some methodological issues raised by undertaking qualitative research in several languages are considered. The research demonstrates how the inclusion of white women in research which operationalises ethnicity minimizes the risk of developing an analysis focusing on "problems" of black and minority ethnic women and encourages the development of general themes which may apply to all women. The analysis focuses on candidacy, that is, women's assessment of risk of their disease, and compliance, that is, the explanations respondents volunteered for accepting or refusing an invitation to attend for mammography. Candidacy and ethnicity emerge as similar constructs, manipulated by women to make claims about their risk of breast cancer. Other, non-medical reasons were given for compliance which serve as a warning about assuming that, when women accept their invitation, they do so for same the reasons the architects of the National Health Service Breast Screening Programme had in mind.
 
Sample characteristics by gender a
Prevalence of lifetime suicide attempts by measures of spiritual commitment for males and females
Article
American Indians exhibit suicide-related behaviors at rates much higher than the general population. This study examines the relation of spirituality to the lifetime prevalence of attempted suicide in a probability sample of American Indians. Data were derived from a cross-sectional sample of 1456 American Indian tribal members (age range 15-57yr) who were living on or near their Northern Plains reservations between 1997 and 1999. Data were collected by personal interviews. Commitment to Christianity was assessed using a measure of beliefs. Commitment to tribal cultural spirituality (or forms of spirituality deriving from traditions that predate European contact) was assessed using separate measures for beliefs and spiritual orientations. Results indicated that neither commitment to Christianity nor to cultural spirituality, as measured by beliefs, was significantly associated with suicide attempts (p(trend) for Christianity=0.22 and p(trend) for cultural spirituality=0.85). Conversely, commitment to cultural spirituality, as measured by an index of spiritual orientations, was significantly associated with a reduction in attempted suicide (p(trend)=0.01). Those with a high level of cultural spiritual orientation had a reduced prevalence of suicide compared with those with low level of cultural spiritual orientation. (OR=0.5, 95% CI=0.3, 0.9). This result persisted after simultaneous adjustment for age, gender, education, heavy alcohol use, substance abuse and psychological distress. These results are consistent with anecdotal reports suggesting the effectiveness of American Indian suicide-prevention programs emphasizing orientations related to cultural spirituality.
 
Top-cited authors
Michael G Marmot
  • University College London
Sally Macintyre
  • University of Glasgow
Cathy Charles
  • McMaster University
Teresa Seeman
  • University of California, Los Angeles
Johannes Siegrist
  • Heinrich-Heine-Universität Düsseldorf